Title

Authors

Document Type

Master's Culminating Experience

Publication Date

8-6-2012

Abstract

Background: Prenatal Care has been recommended by the World Health Organization for all pregnant women in order to improve health outcomes of the mother and the child. However, recommendations for the number of visits required to provide adequate health care and improve outcomes continue to be debated. Understanding if adequate prenatal care is improving maternal child outcomes is essential before making these recommendations. This research aims to determine if in Montgomery County, OH the adequacy of prenatal care influenced gestational age at birth, birth weight, breastfeeding rate, rate of cesarean sections, and smoking cessation rates.

Methods: De-indentified birth data was collected from Public Health - Dayton & Montgomery County for 2007-2009. Data regarding patient demographics, number of prenatal visits, gestational age of newborn, birth weight, breastfeeding rate, smoking cessation, and method of delivery was extrapolated from the original data set. Using ACOG guidelines, the number of women who received adequate (11 or more prenatal visits) and inadequate prenatal care and their outcomes (gestational age, birth weight, breastfeeding, cesarean section rate, and smoking cessation) was determined. Chi squared, Odds Ratio’s, and logistic regression were used to determine statistical significance for each outcome based on adequacy of prenatal care.

Results: The odds of having a premature baby were significantly increased (OR 1.78; CI1.61, 1.97) for woman who received inadequate prenatal care. Odds of low birth weight for inadequate prenatal care (<11 >visits) was 1.89 (1.71-2.08). The odds of breastfeeding were 1.6 (1.52; 1.72) times greater if having received adequate prenatal care, the odds of receiving a cesarean section with adequate prenatal care was 1.23 (CI: 1.14; 1.32), and the odds of quitting smoking was 1.21 (CI: 1.00; 1.46).

Conclusion: Adequate prenatal care positively affected the risk of premature birth, low birth weight, and significantly increased breastfeeding rates. However, risk of cesarean section was significantly more likely if the woman received adequate prenatal care, raising concern for inappropriate encouragement by physicians. Smoking cessation rates showed no difference based on adequacy of prenatal care which demonstrated that woman who quit smoking were motivated by something more than just increased interaction with their physician.